Definitions and exclusions

Definitions

Family
Family is defined as spouse and dependent children.

Spouse
Spouse means your spouse by marriage or under any other formal union recognized by law; or a person of the opposite sex or of the same sex who is publicly represented as your spouse for a period of at least 12 months. You can only cover one spouse at a time. Discontinuance of cohabitation terminates the eligibility of a common-law spouse.

Dependent children
Dependent children means you or your spouse's children (other than a foster child) who are not married or in any other formal union recognized by law, and are under the age of 21 (age 25 if a full-time student), as long as the child is entirely dependent on you for financial support including if a child becomes handicapped before the limiting age. We will continue coverage as long as the child is incapable of financial self-support because of a physical or mental disability and the child depends on you for financial support, and is not married nor in any other formal union recognized by law. A dependent child may only be insured by one member covered under the plan.

Definition of Total Disability
You are considered totally disabled if you are prevented by illness from performing any occupation you are or may become reasonably qualified for by education, training or experience.

Definitions of losses

Loss of an arm means that it was severed at or above the elbow.
Loss of a hand means that it was severed at or above the wrist.
Loss of a leg means that it was severed at or above the knee.
Loss of a foot means that it was severed at or above the ankle.
Loss of a thumb, finger or toe means that it was severed at or above the first joint from the hand or foot.
Loss of sight, speech or hearing must be total and permanent.

Loss of use must be total and must have continued for at least one year. Before  a benefit is paid, you must provide proof that the loss is permanent.

Accidental Death and Dismemberment Insurance exclusions

No benefit will be paid for any loss directly or indirectly due to or resulting from one or more of the following:

  • self-inflicted injury, attempted suicide or suicide, regardless of whether you have the ability to form the requisite intent or regardless of whether you have a mental illness such that you do not know or understand the consequences of the your action(s);
  • a drug overdose;
  • carbon monoxide inhalation;
  • flying in, descending from or being exposed to any hazard related to an aircraft while
    • receiving flying lessons;
    • performing any duties in connection with the aircraft;
    • being flown for a parachute jump;
    • a member of the armed forces if the aircraft is under the control of or chartered by the armed forces;
  • the hostile action of any armed forces, insurrection or participation in a riot or civil commotion;
  • full-time service in the armed forces of any country;
  • participation in a criminal offence.